GB 17057-1997 Diagnosis of occupational acute chemical poisoning Part 9: Diagnosis of occupational acute chemical poisoning heart disease
Some standard content:
GB17057—1997
In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time and suffer from acute poisoning. These chemicals may be known species, or their exact pathogenic species may not be known for a while after poisoning has occurred. Some species are listed in the "Occupational Disease List", while others are not yet included; some have independent diagnostic standards, while others have not yet developed independent diagnostic standards. However, all acute poisoning diseases have common pathogenic laws, and it is possible and necessary to formulate rules that should be followed when diagnosing acute poisoning. The various rules specified in this series of standards involve the diagnosis of occupational acute chemical poisoning. These rules are used to ensure the unification of the diagnostic system of occupational acute chemical poisoning. Regardless of whether the cause is known or hidden, and regardless of which target organ is damaged by poisoning, the diagnosis can be made according to the rules specified in this standard. The various rules specified in this standard are in full compliance with the provisions of GB/T1.1-1993 and GB/T1.22—1993. Under the general title of "Diagnosis of occupational acute chemical poisoning", it includes the following 10 parts: Part 1 "General principles for diagnosis of occupational acute chemical poisoning"; Part 2
Part 3
Part 4
Part 5
Part 6
"Diagnosis of occupational acute latent chemical poisoning"; "Diagnosis of multiple organ failure caused by occupational acute toxicity"; "Diagnosis of occupational acute chemical-induced sudden death"; "Diagnosis of occupational acute toxicity Diagnosis of Nervous System Diseases: Diagnosis of Occupational Acute Chemical Poisoning Respiratory Diseases; Part 7
Diagnosis of Occupational Acute Toxic Liver Diseases; Part 8
Diagnosis of Occupational Acute Toxic Nephropathy; Diagnosis of Occupational Acute Chemical Poisoning Heart Diseases; Part 9
Part 10 "Diagnosis of Occupational Acute Chemical Poisoning Blood System Diseases"; This standard specifies the diagnostic rules for occupational acute toxic heart disease. Appendix A of this standard is a prompt appendix. wwW.bzxz.Net
This standard was proposed by the Ministry of Health of the People's Republic of China. The responsible drafting units of this standard are: the Second Affiliated Hospital of Shanxi Medical College, Tianjin Institute of Occupational Disease Prevention and Control; participating drafting units: Xi'an Central Hospital, Shanghai Sixth People's Hospital, Shanghai Zhabei District Central Hospital. This standard is interpreted by the Chinese Academy of Preventive Medicine, the technical management unit entrusted by the Ministry of Health. 401
National Standard of the People's Republic of China
Diagnosis of occupational acute chemicals poisoning
Part 9: Diagnosis of occupational acute toxic cardiopathy
Diagnosis of occupational acute chemicals poisoning Part 9: Diagnostic criteria of occupational acute toxic cardiopathy GB 17057-1997
Occupational acute toxic cardiopathy is a disease caused by chemicals damaging the heart and affecting its pump function, autonomy or conductivity during various occupational acute chemical poisoning processes. 1 Scope
This standard specifies the general diagnostic criteria and treatment principles for occupational acute chemical poisoning cardiopathy. This standard is applicable to various heart diseases caused by occupational acute chemical poisoning. This standard can also be used as a reference for the diagnosis of heart diseases caused by non-occupational acute chemical poisoning.
2 Cited standards
The provisions contained in the following standards constitute the provisions of this standard through reference in this standard. When this standard is published, the versions shown are valid. All standards will be revised, and parties using this standard should explore the possibility of using the latest versions of the following standards. GB16852.1-1997 Diagnosis of occupational acute chemical poisoning Part 1: General principles for diagnosis of occupational acute chemical poisoning GB16852.2-1997 Diagnosis of occupational acute chemical poisoning Part 2: Diagnosis of occupational acute latent chemical poisoning
3 Diagnostic principles
Based on the occupational exposure history of high concentrations of chemical poisons in a short period of time, clinical manifestations and on-site investigations, combined with the results of electrocardiograms, myocardial enzyme spectra, chest X-rays, etc., it is consistent with toxic heart disease and similar diseases caused by other reasons are excluded before diagnosis can be made. Clinically, it can be divided into two categories: acute toxic myocardial damage and arrhythmia. The former is mainly diagnosed based on changes in electrocardiogram ST-T and myocardial enzyme spectrum, while the latter can show various arrhythmias on electrocardiogram. Both clinical manifestations may also appear at the same time. 4 Diagnosis and classification standards
4.1 Observation subjects
After confirming occupational acute poisoning, one of the following conditions occurs: a) Mild elevation of myocardial enzyme spectrum;
b) QT interval prolongation on electrocardiogram;
c) Occasional premature beats.
4.2 Mild toxic heart disease
Approved by the State Administration of Technical Supervision on November 11, 1997, 402
Implementation on December 1, 1998
One of the following conditions occurs:
a) Significant increase in myocardial enzyme spectrum;
GB 17057—1997
b) Various common arrhythmias, such as frequent premature beats and supraventricular tachycardia; c) I degree atrioventricular block;
d) Electrocardiogram shows mild abnormal changes in ST-T. 4.3 Moderate toxic heart disease
Anyone who has one of the following conditions:
a) Severe arrhythmia, such as atrial fibrillation or flutter, ventricular tachycardia; b) 1st degree atrioventricular block;
c) Myocardial damage, ischemia or myocardial infarction-like changes in the electrocardiogram. 4.4 Severe toxic heart disease
Anyone who has one of the following conditions:
a) Myocardial infarction,
b) Torsades de pointes, ventricular fibrillation or flutter; c) Ⅱ degree atrioventricular block;
d) Cardiogenic shock or congestive heart failure, e) Sudden cardiac death.
5 Treatment principles
5.1 Rescue acute poisoning according to the treatment principles in the General Principles of Diagnosis of Occupational Acute Chemical Poisoning. 5.2 Take special treatment measures according to the cause. 5.3 Patients should absolutely stay in bed, correct hypoxia in time, maintain water, electrolyte and acid-base balance, and have a reasonable nutrition. 5.4 Treatment of myocardial damage
a) Give drugs that improve myocardial cell nutrition and metabolism, such as potassium magnesium aspartate, polarization fluid, coenzyme Q10, 1,6-diphosphate fructose (FDP), vitamin C, vitamin B, etc.; b) Use adequate glucocorticoids as early as possible;
c) Drugs that improve coronary circulation, such as nitrates, calcium antagonists, low molecular weight dextran, etc.; d) In case of congestive heart failure, digitalis drugs, diuretics, and dopamine can be used with caution. 5.5 Treatment of arrhythmia
a) Correct hyperkalemia or hypokalemia,
b) For rapid arrhythmia, such as atrial fibrillation or flutter, supraventricular tachycardia, vertebrol can be used, and for ventricular tachycardia, lidocaine can be used. Potassium-magnesium mixture has a good effect on torsades de pointes. When drugs are ineffective for atrial fibrillation, electric defibrillation can be considered, c) For slow arrhythmia, when there is atrioventricular block, atropine, ephedrine or isoproterenol, glucocorticoids can be used, and temporary pacemaker can be used when necessary,
d) Other treatment principles are the same as those for internal medicine.
6 Assessment of labor capacity
6.1 After the observation object and mild toxic heart disease are fully recovered after treatment, they can return to their original work. 6.2 After the moderate toxic heart disease is recovered after treatment, they can generally engage in normal work. 6.3 Severe toxic heart disease
After treatment, arrange work or rest according to the recovery situation. 403
Health examination requirements
7.1 Employment physical examination
GB17057-1997
All workers engaged in hazardous work should undergo an employment physical examination, which should include electrocardiogram examination in addition to the items required for various chemical poisoning. 2 Regular physical examination
Periodic physical examinations should be carried out according to the regulations based on the types of toxic substances exposed, and the items are the same as those for employment physical examinations. Occupational general certificate
Patients with various organic heart diseases; those with functional arrhythmias. 404
GB 170571997
Appendix A
(Suggested Appendix)
Correct use of standard instructions
A1 This standard applies to the diagnosis, classification and treatment of heart disease caused by occupational acute chemical poisoning, and can be used as a reference for heart disease caused by acute poisoning in daily life.
A2 Common causes
a) Asphyxiating gases: carbon monoxide, hydrogen sulfide, cyanide, methane, nitrogen, carbon dioxide. b) Pesticides: lindane, DDT, mancozeb; fluoroacetamide, sodium fluoroacetate; pyrethroids (cypermethrin, deltamethrin, etc.), insecticides; carbamates, propanil, etc. c) Metals and non-metals: mercury, arsenic, arsine, lead, antimony, barium, cobalt, thallium, phosphorus, etc. d) Irritant gases: ammonia, chlorine, phosgene, nitrogen dioxide, dimethyl sulfate, methyl chloroformate, organic fluorine, hydrofluoric acid, phosphine, phosphorus trifluoride, chloroformaldehyde, monomethylamine, carbonyl nickel.
e) Halogenated hydrocarbons: tetrachloroethylene, vinyl chloride, ethyl chloride, trichloroethane, tetrachloroethane, trichloropropane, ethylene oxide, ethyl bromide, propyl bromide, fluoroform.
f) Organic solvents: benzene, toluene, gasoline, carbon tetrachloride, carbon disulfide. g) Methemoglobin formers: aniline, nitrite. h) Others: phenol, fluoroacetic acid, sodium azide, allylamine, ethyl gasoline, borane, chromic anhydride, etc. A3 Pathogenesis
a) Direct toxic effects of poisons on the myocardium and (or) conduction system. b) Indirect causes such as hypoxia, electrolyte disturbance, and acid-base imbalance after poisoning. A4 Clinical features of occupational acute toxic heart disease a) All have a history of short-term exposure to high concentrations of chemicals. b) Have clinical manifestations unique to the chemical poisoning. c) Clinical and electrocardiographic changes of acute toxic heart disease are non-specific and often masked by the critical symptoms of poisoning, and are easily overlooked.
d) Myocardial damage often occurs 1 to 7 days after poisoning, and some even occur during the recovery period of poisoning. e) The more severe the poisoning, the more chances of myocardial damage, the earlier it occurs, and the more severe the degree. f) Most patients can gradually return to normal as the poisoning situation improves. A5 Clinical manifestations of toxic heart disease
a) Symptoms: palpitations, shortness of breath, weakness, chest tightness, and dyspnea. Sometimes due to the serious condition, the patient is in a coma without any complaints. b) Physical signs: purple, decreased blood pressure, enlarged heart, faster or slower heart rate, low and dull heart sounds, arrhythmia, and in severe cases, diastolic gallop rhythm and moist rales in both lungs can be heard.
c) Electrocardiogram: common QT interval prolongation, ST-T changes, varying degrees of atrioventricular block, and various types of arrhythmias. d) Chest X-ray: Cardiac enlargement can be seen. Pulmonary edema caused by irritant gas poisoning can be seen with prominent pulmonary artery segments, and the lung fields show dot-shaped, flake-shaped or butterfly-shaped shadows.
e) Others: elevated myocardial enzymes, abnormal examinations such as cardiac color Doppler ultrasound, two-dimensional echocardiography, dynamic electrocardiogram, and ECT can provide a deep understanding of changes in heart size, myocardial hypertrophy, ventricular enlargement, and cardiac function. A6 Diagnostic steps and methods
a) First, confirm acute poisoning and its degree based on the history of exposure to high-concentration chemicals, on-site investigation, clinical and laboratory examination data. b) Based on the clinical manifestations and signs of myocardial damage. c) For acutely poisoned patients, routine electrocardiograms should be performed, and continuous dynamic electrocardiogram monitoring should be performed for critically ill patients. 405
GB17057—1997
d) Myocardial enzymes, serum electrolyte tests, and blood gas analysis. e) Chest X-ray.
f) Echocardiogram, two-dimensional echocardiogram, dynamic electrocardiogram, cardiac color Doppler ultrasound, cardiac ECT and other examination results. g) Based on the above information, comprehensive analysis, and exclusion of other similar diseases, a diagnosis can be made. Electrocardiogram is the most reliable basis for the diagnosis of toxic heart disease.
A7 The naming and writing format of occupational acute toxic heart disease is standardized. The diagnosis naming format can be clear at a glance, which is conducive to the accumulation of clinical data, guidance of treatment, and timely treatment and subsequent research. The standard principle of naming is to indicate the name of the type of heart disease after the diagnosis classification. The expression is as follows: a) Acute mild toxic heart disease:
1) Acute mild toxic heart disease (myocardial damage); 2) Acute mild toxic heart disease (supraventricular tachycardia), 3) Acute mild toxic heart disease (myocardial damage combined with first-degree atrioventricular block). b) Acute moderate toxic heart disease:
1) Acute moderate toxic heart disease (ventricular tachycardia); 2) Acute moderate toxic heart disease (first degree atrioventricular block); 3) Acute moderate toxic heart disease (myocardial ischemic damage combined with first degree atrioventricular block). c) Acute severe toxic heart disease:
1) Acute severe toxic heart disease (myocardial infarction with congestive heart failure); 2) Acute severe toxic heart disease (first degree atrioventricular block with cardiogenic shock). And so on.Moist rales in both lungs, etc.
c) Electrocardiogram: common QT interval prolongation, ST-T changes, atrioventricular block of varying degrees, various types of arrhythmias. d) Chest X-ray: cardiac enlargement can be seen. Pulmonary edema caused by irritant gas poisoning can be seen with prominent pulmonary artery segments, and the lung fields show dot, sheet-like shadows or butterfly-shaped shadows.
e) Others: elevated myocardial enzyme spectrum, abnormal examinations such as cardiac color ultrasound, two-dimensional echocardiography, dynamic electrocardiogram, and ECT can provide in-depth understanding of changes in heart size, myocardial hypertrophy, ventricular enlargement, and cardiac function. A6 Diagnostic steps and methods
a) First, confirm acute poisoning and its degree based on the history of exposure to high-concentration chemicals, on-site investigation, clinical and laboratory test data. b) Based on the clinical manifestations and signs of myocardial damage. c) For patients with acute poisoning, routine electrocardiogram examinations should be performed, and continuous dynamic electrocardiogram monitoring should be performed for critically ill patients. 405
GB17057—1997
d) Myocardial enzyme spectrum, serum electrolyte test and blood gas analysis. e) X-ray chest film.
f) Ultrasound cardiogram, two-dimensional ultrasound electrocardiogram, dynamic electrocardiogram, cardiac color Doppler ultrasound, cardiac ECT and other examination results. g) Based on the above information, comprehensive analysis, and exclusion of other similar diseases, a diagnosis can be made. Electrocardiogram is the most reliable basis for the diagnosis of toxic heart disease.
A7 The naming and writing format of occupational acute toxic heart disease is standardized. The diagnosis naming format can be clear at a glance, which is conducive to the accumulation of clinical data, guidance of treatment, and timely treatment and subsequent research. The standard principle of naming is to indicate the name of the type of heart disease after the diagnosis classification. The expression is as follows: a) Acute mild toxic heart disease:
1) Acute mild toxic heart disease (myocardial damage); 2) Acute mild toxic heart disease (supraventricular tachycardia), 3) Acute mild toxic heart disease (myocardial damage combined with first-degree atrioventricular block). b) Acute moderate toxic heart disease:
1) Acute moderate toxic heart disease (ventricular tachycardia); 2) Acute moderate toxic heart disease (first-degree atrioventricular block), 3) Acute moderate toxic heart disease (myocardial ischemic damage combined with first-degree atrioventricular block). c) Acute severe toxic heart disease:
1) Acute severe toxic heart disease (myocardial infarction with congestive heart failure); 2) Acute severe toxic heart disease (first-degree atrioventricular block with cardiogenic shock). And so on.Moist rales in both lungs, etc.
c) Electrocardiogram: common QT interval prolongation, ST-T changes, atrioventricular block of varying degrees, various types of arrhythmias. d) Chest X-ray: cardiac enlargement can be seen. Pulmonary edema caused by irritant gas poisoning can be seen with prominent pulmonary artery segments, and the lung fields show dot, sheet-like shadows or butterfly-shaped shadows.
e) Others: elevated myocardial enzyme spectrum, abnormal examinations such as cardiac color ultrasound, two-dimensional echocardiography, dynamic electrocardiogram, and ECT can provide in-depth understanding of changes in heart size, myocardial hypertrophy, ventricular enlargement, and cardiac function. A6 Diagnostic steps and methods
a) First, confirm acute poisoning and its degree based on the history of exposure to high-concentration chemicals, on-site investigation, clinical and laboratory test data. b) Based on the clinical manifestations and signs of myocardial damage. c) For patients with acute poisoning, routine electrocardiogram examinations should be performed, and continuous dynamic electrocardiogram monitoring should be performed for critically ill patients. 405
GB17057—1997
d) Myocardial enzyme spectrum, serum electrolyte test and blood gas analysis. e) X-ray chest film.
f) Ultrasound cardiogram, two-dimensional ultrasound electrocardiogram, dynamic electrocardiogram, cardiac color Doppler ultrasound, cardiac ECT and other examination results. g) Based on the above information, comprehensive analysis, and exclusion of other similar diseases, a diagnosis can be made. Electrocardiogram is the most reliable basis for the diagnosis of toxic heart disease.
A7 The naming and writing format of occupational acute toxic heart disease is standardized. The diagnosis naming format can be clear at a glance, which is conducive to the accumulation of clinical data, guidance of treatment, and timely treatment and subsequent research. The standard principle of naming is to indicate the name of the type of heart disease after the diagnosis classification. The expression is as follows: a) Acute mild toxic heart disease:
1) Acute mild toxic heart disease (myocardial damage); 2) Acute mild toxic heart disease (supraventricular tachycardia), 3) Acute mild toxic heart disease (myocardial damage combined with first-degree atrioventricular block). b) Acute moderate toxic heart disease:
1) Acute moderate toxic heart disease (ventricular tachycardia); 2) Acute moderate toxic heart disease (first-degree atrioventricular block), 3) Acute moderate toxic heart disease (myocardial ischemic damage combined with first-degree atrioventricular block). c) Acute severe toxic heart disease:
1) Acute severe toxic heart disease (myocardial infarction with congestive heart failure); 2) Acute severe toxic heart disease (first-degree atrioventricular block with cardiogenic shock). And so on.
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